http://exhibits.library.stonybrook.edu/mfp/files/original/d30b69ef69a8cf00c194481df0db03be.pdf 468179c0544d033b07449c4407b71b92 PDF Text Text Reprinted from THE JOURNAL OF Volume 130, NERvots AND MENTAL DIsEAsE No. 3, March 1960 Printed in (ISA. SOCIAL ATTITUDE (CALIFORNIA F SCALE) AND CONVULSIVE THERAPY ROBERT L. KAHN, PH.D.,1 MAX POLLACK, PH.D. . ,\— AND MAX FINK, M.D. improved was most likely in those who were Studies of the mode of action of convulsive therapy in altering behavior have been under investigation by a variety of experimental methods in our laboratory for several years. Early studies demonstrated a relationship between clinical evaluations of improvement and the degree of altered brain function as measured by the amobarbital test (15) and the electroencephalogram (5). Personality patterns related to a favorable therapeutic outcome have been defined by family interviews (13) and projective techniques (14). Behavioral changes have been measured by complex visual and tactile perceptual tasks (6) and by analyses of changes in syntactical aspects of language (12). More recently we have become increasingly aware of the relation of sociopsycho— logical factors to differences in both referral for, and response to, convulsive therapy. In a study of the entire adult iii-patient population of Hillside Hospital it was found that those patients referred for convulsive therapy were significantly older, more likely to have been foreign-born, had less education and higher scores on the California F Scale than those patients who received psychotherapy alone (17). Of those patients receiving convulsive therapy, a favorable therapeutic evaluation of recovered or much older, more poorly educated, foreign—born and with higher F scores (18). The aim of the present investigations was to study the convulsive therapy process further by the use of the California F Scale (1). Although promulgated in a setting where interest was focused on prejudice and au— thoritarianism, the F Scale was designed to evaluate psychological aspects, such as con— ventionalism, rigidity and stereotypy, related to the manifestation of these social attitudes. It was our specific purpose to determine: 1) what the F Scale measures in a psychiatric population, and 2) how response to the F Scale varies with change in brain function. METHOD Population: These studies have been conducted at Hillside Hospital, a private, nonprofit 200-bed psychiatric hospital in New York City admitting voluntary patients with “early and curable mental illness.” Psychoanalytically—oriented psychotherapy is the treatment of choice for all patients, with somatic therapies (convulsive, insulin coma and drug therapies) regarded as ancillary, but available when needed. The in—patient population consists mainly of middle-class Jewish patients, with a high school education. between the ages of 18 and 40. Most patients are classified into the diagnostic categories of schizophrenia, psychoneurosis, manic-depressive and involutional psychosis. In these studies we have used a ten-item modification of the standard F Scale (8). Department of Experimental Psychiatry, Hillside Hospital, Glen Oaks, Long Island, New York. This investigation was supported in part by grants M-927 and MYw2092 from the National Institute of Mental Health, National Institutes of Health, U. S. Public Health Service. This paper derives from a presentation given at the Annual Meeting of the Eastern Psychological Association, Philadelphia, 1 April, 1958. 187 �188 KAHN, POLLACK AND FINK TABLE 1 Scores on Conventional and “Reverse” F Scales Dichoto— (grilled I‘OU p S M chzi: iN Cpnv erll— iona Scale hi3: ‘Reverse”' _ Diff. t 51.5 48.1 +25.2 +0.7 20.3* : Scale I 10—37 38—70 * 79' Significanti _ at .001 0.6 level The procedure consists of having the subject read ten statements and indicating to what extent he agrees or disagrees with each, i.e. a little, pretty much, or very much. The score for each item ranges from one to seven, and the total score range is 10 to 70, with high scores indicating greater agreement with the statements. The statements are extreme, uncritical or stereotyped expres— sions, such as: “No sane, normal, decent person would ever think of hurting a close friend or relative” and “If people would talk less and work more, everybody would be better off.” RESULTS ment with the statements. In contrast, the patients who made high scores initially showed little change on retesting, indicating that they agreed with the statements to the same extent even when their meanings were reversed. Change in F Score with convulsive therapy. In a second study, 69 consecutive hospitalized patients referred for convulsive therapy were given the F Scale in the week prior to treatment, on the day following the 12th treatment, and two weeks after the termination of treatment. These patients were divided into two groups; an experimental group of 59, and a control group of ten patients randomly selected from the referrals. In the experimental group all patients received grand mal convulsive therapy, while the control group received subconvulsive electro-stimulation only. All patients were treated three times a week, for a minimum of 12 treatments. The degree of physiologic change during treatment was determined by quantitative analyses of delta activity in the EEG, using techniques previously described (5). EEG records were obtained weekly and the records taken nearest the 12th treatment were measured for the degree of induced slow wave activity (the per cent time occupied by waves of 6 cps or slower for 66 seconds of recording from the anterior temporal—vertex leads). The changes in F score during convulsive treatment are shown in Table 2. There was a mean increase of +5.7 in F score during What the F Scale measures in this population: the “reverse” F Scale. In this study the entire in-patient population was first tested with the conventional scale, then retested one month later with a “reverse” scale (2). In the “reverse” scale the same items are used, but stated in opposite terms to the original. Thus, the first example cited above is changed to read, “A sane, normal, decent person might have to hurt a close friend or relative.” The “reverse” scale is scored in the same manner as the regular scale, with TABLE 2 Efiect of Convulsive Treatment on F Score high scores reflecting greater agreement. The relation of the scores on the convenMean F Score tional to the “reverse” scales is shown in N PreTable 1. The patients were divided into two Mean During t Treatment Difference 22:? the to median groups according score on the conventional scale. Those patients who made Convulsive 59 45.3 51.0 2.02* +5.7 low scores initially, indicating predominant Group 10 48.7 disagreement with the statements, showed a Control 49.2 +0.5 0.02 Group significant increase in score on the “reverse” * scale, indicating that they were now in agreeSignificant at .05 level �189 SOCIAL ATTITUDE AND ECT treatment, a difference significant at the five the of confidence. In level cent contrast, per control group showed a statistically insignificant change during the same period. The effect of convulsive therapy on the F score was further demonstrated by an analysis of seven patients, originally in the control group, who were subsequently placed on a regular course of convulsive therapy. On retest after 12 control treatments their scores were unchanged, with a mean difference from the pretreatment score of +0.1. After 12 convulsive treatments, however, these patients showed a significant mean increase of +9.1. Adequate EEG records at the time of the 12th treatment were obtained for 54 patients. For this analysis the records were divided into two groups according to the degree of slow wave activity: a high delta index group in whom slow wave activity appeared in 40 per cent or more of the selected leads, and a low delta index group in whom the slow wave activity was less than 40 per cent. Changes in F scores during treat— ment for the two groups are shown in Table 3. TABLE 3 Change in F Score and Degree of Induced Cerebral Dysfunction Mean Treatment Treatment Difference Pre- During 27 43.9 52.5 +8.6 23* 27 45.6 49.0 +3.4 0.8 Degree of Slow Wave Activity High Delta Index Low Delta Index * 15 Significant at .05 level The patients with high degrees of slow wave activity had a mean increase in F score of +8.6, significant at the five per cent level of confidence. Those patients with low delta indices showed a relatively small increase of +3.4. While the increase in scores in the low delta activity group was statistically insignificant, it was greater than that of the control group (Table 2). TABLE 4 Pre-Treatment and Post—Treatment F Scores Pre— Post— 21 42.2 40.6 —1.6 0.4 16 42.6 42.1 —0.5 0.1 N High Delta Index Low Delta Index .Mean Treatment Treatment Diflerence I F scores were obtained in 44 patients two weeks after the last treatment (Table 4). The mean difference between pre— and posttreatment scores was statistically insignificant. Furthermore, the same pattern of a small decrease in score was found for both the high and low delta activity groups. DISCUSSION These observations demonstrate the relevance of the F Scale to the convulsive ther— of these An understanding apy process. relationships requires examination of the psychological factors reflected by the F Scale in our population. The observations on the “reverse” F Scale indicate that those patients who disagreed with the original statements (low F score) were responding to the content of the state— ments. This was shown by the high degree of agreement with the reverse statements. Those patients who agreed with the original statements (high F score), however, continued to agree when the statements were reversed. Evidently, these patients were not responding to the content of the statements, but demonstrated a more generalized reac— tion. There have been several studies on non— psychiatric populations using a “reverse” F Scale, with conflicting results. Thus, Chris— tie, Havel and Seidenberg (3) have found a consistent response to content in original and reverse scales, e.g., agreeing to one and disagreeing with the other, while Jackson, Messick and Solley (10) report a positive correlation between agreement on the two scales. In part, these differences may be accounted for by differences in the form of the reversed �190 KAHN, POLLACK AND FINK scale. Jackson and Messick (9) indicated that Christie ct al. (3) modified the language form of the original scale and reversed the content, while Jackson et al. (10) retained the extreme, cliché—ridden style of the origi— nal scale. Jackson and Messick indicate that the response pattern to the F Scale may be interpreted in terms of response style rather than specific item content. On the basis of the data from our population there is a difference between the high and low scorers with respect to the extent that cognitive style affects their response. The high scorers who agree with both forms of the scale show a consistent style of response acquiescence, overgeneralization and conforming to so— cially desirable standards. Those who scored low on the original scale, however, did not show the converse—a consistent pattern of negativism or social non-conformity. Rather, they altered their style to agree with the con— tent when the statements were reversed. Thus, low F score patients were characteristically more critical and discriminating persons, While those with high F scores were more undifferentiating and stereotyped in their reactions. With this conception of the F Scale, the findings in convulsive therapy may be considered. In the selection of treatment in this institution, those patients receiving convul— sive therapy had significantly higher scores than those receiving psychotherapy only (17). That this observation is not simply a reflection of diagnosis is seen in the differentiation by the F score of the selection of treatment even among those patients classi— fied as psychotic depression. The selection of treatment thus seems related to psycho— logical processes reflected in the F Scale. Subjects with high F scores, with stereotypy of thinking and difficulty in introspection, often present a behavioral pattern incompatible with the establishment of the type of interpersonal relationships required in psychoanalytically-oriented psychotherapy. The favorable evaluations of therapeutic response to convulsive therapy in patients with high F scores may be related to personality attributes. The psychological processes reflected in the F Scale are similar to those personality factors previously found to be related to a favorable response to such treatment. In structured family interviews it was observed that the favorably rated patients had personality patterns characterized as nonempathic, nonintrospective, nonverbally communicative, and highly conventional and stereotyped, with little imagi— native or creative capacity (13). Consistent patterns have been shown in Rorschach studies indicating that good prognosis is re— lated to a small number of responses, absence of human movement and little diversification of content (7, 14). The F score increases significantly with convulsive therapy with the extent of in— crease related to the degree of altered brain function, as measured by the degree of induced EEG slow wave activity. This relation of change in behavior to physiological change is an observation that has been consistently noted in convulsive therapy patients (5). The increase in F score during treatment may have been even more marked than actually observed. Several patients of foreign birth and little education had maximum or near maximum scores prior to treatment, thus eliminating or reducing the possibility of an increase on retesting. The change in score with altered brain function is consistent with previous observations on the behavioral effects of convulsive therapy. In accord with our conceptual framework, greater agreement with F Scale items during treatment is related to increased stereotypy and difficulty in discrimination, as well as to increased acquiescence. This is part of a general process which has been noted in linguistic, perceptual and clinical behavioral measures. In their language, convulsive therapy patients show increased denial, evasion, qualification and use of clichés and stereotyped expressions �SOCIAL ATTITUDE AND ECT (12). They also manifest increased repetitiveness of words (11), difficulty in complex visual and tactile perception (6) and figureground discrimination (16). Clinically, they are characteristically more compliant and acquiescent and try to please the examiner (4). SUMMARY A measure of social attitude, the California F Scale, has been utilized in studies of the convulsive therapy process. In a voluntary psychiatric hospital it was noted that patients referred for convulsive therapy had significantly higher F scores than those re— ceiving psychotherapy only. Among the patients receiving convulsive therapy, those with the higher initial F scores were evalu— ated as showing the best clinical results. With treatment there was a significant increase in F score, with the increase related to the degree of altered brain function. Follow— ing treatment the scores returned to their original level. Comparison of results with a conventional and “reverse” F Scale demonstrated that patients with low F scores respond to the content of the questionnaire, while those with high F scores showed a generalized of the con— of independent agreement pattern tent. These results are interpreted in terms of the psychological processes measured by the F Scale. High—scoring patients are considered to be stereotyped in their thinking and to have difficulty in introspection—behavior which is incompatible with psychoanalytically-oriented psychotherapy, rendering them more liable to referral for convulsive therapy. With treatment, such patients are also more likely to develop the language patterns of denial and use of clichés which are the cues for evaluations of clinical improvement. The increase in F score with treatment is comparable to other types of behavioral change, such as increased acquiesin figure-ground increased difficulty cence, 191 discrimination, and increased stereotypy of language. REFERENCES 1. ADORNO, T. W. ET AL. The Authoritarian Personality. Harper, New York, 1950. 2. BAss, B. M. Authoritarianism or acquiescence? J. Abnorm. & Social Psychol., 51: 611—623, 1955. 3. CHRISTIE, R., HAVEL, J. AND SEIDENBERG, B. Is the F Scale irreversible? J. Abnorm. & Social Psychol., 56: 143—159, 1958. 4. FINK, M. AND KAHN, R. L. Behavioral patterns in induced states of altered brain function. Paper read at Divisional Meeting, Am. Psychiat. Ass., New York, November, 1957. 5. FINK, M. AND KAHN, R. L. Relation of EEG delta activity to behavioral response in electroshock: quantitative serial studies. AMA Arch. Neurol. & Psychiat., 78: 516—525, 1957. M., KAHN, R. L. AND KORIN, H. Effects of diffuse altered brain function on perception. Internat. Congr. Psychol, Proc., 15: 6. FINK, 238—239, 1959. 7. FINK, M., KAHN, R. L. AND POLLACK, M. Psychological factors affecting individual differences in behavioral response to con— vulsive therapy. J. Nerv. & Ment. Dis, 128: 243—248, 1959. J. AND ERLICH, I. Some sociopsychological characteristics of patients and their relevance for psychiatric treatment. In The Patient and the Mental Hospital, Greenblatt, M., Levinson, D. J. and Williams, R. H., eds., pp. 357—379. Free Press, Glencoe, 111., 1957. 9. JACKSON, D. N. AND MEssroK, S. J. Content and style in personality assessment. Psychol. Bull., 55: 243—252, 1958. 10. JACKSON, D. N., MESSICK, S. J. AND SOLLEY, C. M. How “rigid” is the authoritarian? J. Abnorm. & Social Psychol., 54: 137—140, 8. GALLAGHER, E. B., LEVINSON, D. 1957. J., FINK, M. AND KAHN, R. L. Com— munication patterns with altered brain function. J. Nerv. & Ment. Dis., 130: 235—239, 11. JAFFE, 1960. 12. KAHN, R. L. AND FINK, M. Changes in language during electroshock therapy. In Psy— chopathology of Communication, Hoch, P. and Zubin, J., eds., pp. 126—319. Grune & Strat— ton, New York, 1958. 13. KAHN, R. L. AND FINK, M. Personality factors in behavioral response to electroshock therapy. J. Neuropsychiat., 1: 45—49, 1959. 14. KAHN, R. L. AND FINK, M. Prognostic value of Rorschach criteria in clinical response to convulsive therapy. J. Neuropsychiat. In press. 15. KAHN, R. L., FINK, M. AND WEINSTEIN, E. A. Relation of amobarbital test to clinical im- �192 KAHN, POLLACK AND FINK provement in electroshock. A.M.A. Arch. Neurol. & Psychiat., 76: 23—29, 1956. 16. KAHN, R. L., POLLACK, M. AND ure—ground discrimination FINK, M. Fig— after induced altered brain function. A.M.A. Arch. Neurol. In press. 17. KAHN, R. L., POLLACK, M. AND FINK, M. Social factors in the selection of therapy in a vol— untary mental hospital. J. Hillside Hosp, 6: 216—228, 1957. 18. KAHN, R. L., POLLACK, M. AND FINK, M. Sociopsychological aspects of psychiatric treatment. A.M.A. Arch. Gen. Psychiat., 1: 565—574, 1959. , �Social Attitude (Californin 3 Scale) and convulsivo Ihornpy Robort L.Kahn Ph.n., Kn: Polluek Ph.D. and flux rink H.D. Dcpurtnont a! Experimentnl Psychiatry, Hillside Hospital, 61"! 0.1(3' litre, 3.1. ~ IX; 11/10/59 �mu. 1: part, at t» mun run-hum. tannins“. nuuczym, April, ”58. 3*91‘1 1» try at “.2092 «a put. at um, an” “tuna menu» a: mm mu. “an“ Influx“: of Inn“. was. ”In.“ mm: aunt“. �3.3111 Attitude and E0! �Boeial Attitude (Galifornia I Scale) and Convnleive Therapy Studies of the node of action of convulsive therapy in altering behavior have been under investigation by a variety of experimental methods in our laboratory for several years. Early studies demonstrated a relationship between clinical evaluations of inproveaent and the degree of altered brain function as measured by the aaobarbital test (12) and the electroencephalogram (h). Personality patterns related to a favorable therapeutic outeone have been defined by fanily interviews (13) and projective techniques (15). Behavioral changes have been neasured by eeaplex visual and tactile perceptual tasks (6) and by analyses of changes in syntactical aspects of language (16). recently we have become increasingly aware of the relation of seeiopsyehelegieal factors to differences in both referral for, and response to, convulsive therapy. In a study of the entire adult in-patient population of Hillside hospital it was found that these patients referred for convulsive therapy were significantly older, more likely to have been foreign-born, had less education and higher scores on the Californi I Scale than these patients who received psychotherapy alone (17). Of those patients receiving convulsive therapy, a favorable therapeutic evaluation of recovered er much iapreved was nest likely in those who were older, aore poorly educated, foreign-born and with higher 7 scores (18). Here �1h. 31: 0: ts. pr.nunt tavcnttanttonl.wun to turtle: 'utniy tho convulntvo thorny: pronoun h: £3. at. or «p. 6.113.231: r Saul. (1). Althotgh prcanllt‘nd 1: a cutting white tn‘iroat at: located an prtandicc tad luthnrttnrtanxln, tho I Ital. wt: d-utgnod to it‘lxuto paychcloginnl napocto, such a: convontilnlltun, rigidity and Itarcnfiyyy, rclutcd to thy n;nt£cn#n$t¢n a: tin:- :0aiul attitudes. I It wan OI! apuctltc ptrpnna to how und 2) pnychtatrta poyuzntiou, t acaln 1.210: with Chllg! in brain function. 83:19 acanurul 13 rtiptnao $0 it. I naturist. 1) tint tho �KBIEOD: Pepnlationt These studies have been conducted at hillside Hospital, a private, nanoprerit 200 bed psychiatric hospital in New York City adaitting relentary patients with Iearly and enrahle aental illness". rPsyeheanalytiosllyu oriented psychotherapy is the treatment of choice for all (convulsive, with senatie therapies patients, insulin cans and drug therapies) regarded as ancillary, but available when needed. The in-patient populatien epneiste mainly of niddleclass Jewish patients, with a high school education, between the ages of 18 and ho. Most patients are classified into the diagnostic categories of schieophrenia, psychonenrosis, manicdepressive and invelntienal psychosis. In these studies we have need a ten its: aeditieation e! the standard scale (8). The procedure consists of having the subject read ten stateaents and indicating te‘Whet extent he agrees or disagrees with each, i.e. a little, pretty each, or very such. The score for each item ranges tron one to seven, and the tetal sears range is 10 to 70, with high scores indicating greater asreenent with the otatenents. The statenente are extreme, uncritical er stereotyped expressions, such as: "No sane,neraal, deeent person would ever think or hurting a close friend or relative‘ and "If people would talk less and work acre, everybody would be better air.” �RESELISs the 1 Scale Heaenree in our Po nlatione The i'ne'nn-ae'“ F Scale In this stat: the entire in-patient population was tiret tested with the contentional eeale, then reteeted one nenth later with a 'reveree' eeib (2). 'In the "reverse" scale the sane items were need, but stated in opposite terms to the original. Thus the liret example cited above was ohanged to read, ”A aane, normal, decent person night have to hurt a The close friend or relative." 9reverse'eea1e was scored in the eane manner as the regular scale, with high score: reflecting What greater agreement. the relation of the eeoree on the conventional to the “reverse“ eealee 1e ehovn in table I. The patienta were divided into two group: according to the nedian aoore en the conventional eeele. Those patiente who node low eeeree initially, indicating predoninant dieagraeaent with the etatenente, ehoved a significant innfeaae in score on the 'reveree“ scale, indicating that they were not in agreement with the statements. In contrast, the patients who aade high eeoree initially showed little change on retenting, indieating that they agreed with the etatenente to the sane extent even when their meanings were reversed. -u-abfiooogqfi‘mmn—tun‘m Table I about here Dun-Qn-uueembebuufiua-Oepn. �TABLE I Scar-a on Conventional and 'Rovorao' Dichotonisod Graugs Kcan Scorn conventional Soul. ~!_ I fiction noun Score “levcrao' Se&lo Dirt. .£_ 20.3‘ 10-37 76 26.3 51.5 +25. 2 36.70 79 h7.h h8.1 + ”Signitietnt at .001 luvol 0.7 0.6 �.5- I score with cenvuleive theregz. In e eeoond etody, 69 eoneeoutive heepitelieed petiente referred for eonvnleive therepy were given the r seele in the week prior-to treetwent, on the dey following the 12th treetwent, end two weeke etter the terninetion er treeteent. Theee pdiente were divided into two groupe,en experimentel group of 59, end I control group or ten petiente tenderly selected from the reterrelea In the experieentel group e11 petiente reeeived greed eel oeuvuleive therepy, while the control group received enbeonvuleive electro-etieuletien only. All petiente were treeted three tieee e week, for e nininne Change e1 12 in treeteente. , physiologic ohenge during ‘lreetnent wee deterrined by queutitetive enelyeee of delta eotivity in the EEG, neing teehniquee previoneh deeerihed (h). EEG reoorde were ebteined weekly end the reeerde token neereet the 12th treetnent were neeeered for the degree of induced elow were 6 wevee o: by cent ocoopied ope or (the tine eetivity per elewer for 66 eeeonde of recording from the enterior tenperelvertex leede). The ehengee in r eeore during oonvuleive treetnent ere ehewn in Tehb 2. There wee e ween increeee of +5.? in r eeore during treetwent, e difference eignificent et the 55 level of confidence. In contreet, the control group ehowed e etetietieelly iheighitioent chenge during the eeee period. The degree of �.6. it. attics if nouvnlntvt thorny, an in. r atnvn vat tnrihur dcnouatrafiua by a: ina1ruaa if aovoa pattcltug' originallyjtn the nautrll crux», vi. wart t‘§u¢.u¢ut11 plant: ffltfififi 33%.: an «mutilatvu of neuron $hurtyy. rcculur a a: 13 anntral trunthaut: that: Iqurca utrn tuuhauucu. ‘1‘» a mans ditftruuao :tcn tut protrcatunut tutti Q3 «9.1 errorn. Altar 12 nnuvulntvo trtatlcuta, fiauuvur, than. ptiiia‘t unavod :1mm». a: 09.1 anew. “want u» tibla 5h but. it. its. at tin 12th irontntat pflttflt‘fl. In! $htt tnnlyttn tho Instant Adogua§a BIB roaorda var. ubtntnoa tor a about 3% Itvtdndjin£o tut nauupo'nno.r¢ina ‘9 it. 1.33%. at Ilia var. ntilvltyu a high dixfic 13am: group‘tn ulna slaw unvrunttvtty Ip’cntod 1n ho: or nor. 0: ti. stlcutod Ionic. Qua a lll‘lfl‘fi ludax (ran; 1: that th. III! II'. nafilvtty u:Xcal than 801. Gianna. in I lifivflfl fl!rtll $2¢usnoat fur fit. in. groups .9. shut: in rabid 3. warn ‘ .C'OOUMfiOWQ‘fiQD‘OOO‘ Inhla 3 thont but. fl. “’.*“*Q*&.*QOOQQU In. ytfiiunta with high 4.3!!!! a: axon any! aattvity had n o: «8.é. significanfi tt tho 5! 10'01 at conttdtnnc. than. putianta with 10v 401‘: iadlceu uhluud lama ilerillt 1a 9 t¢¢ru �TABLE 2 Effect of Convulsivo Treatnent on r Score Raga P Saute 1 Pre~ treatnont During Treatment Convuluive Group 59 h5.3 51.0 control Group 10 h8.7 h9.2 ‘ Significant at .05 lovcl noun Difference 3 + 5.7 2.02* + 0.5 0.02 �TABLE 3 Chan 0 in r Scare and chroo or 31.u Huvc ctivit De roe o: Induood Cor-bral Pro» ‘g During front-out rroatnont D stunctioa noun Differenco t ligh molt. Index 27 h3.9 52.5 +8.6 2.3“ Lov'nolta Indox 27 h§.6 h9.0 +3.h 0.8 G Significnnt 1t .05 level �-1- relatively small inereuso of +3.h. Hhilo the increase in scores in the low delta nativity group was stutiatioally insignificant, it ran grout-r thtn that or the control a (table 2). 1 score: were abtainod in hh patient: two racks utter the 1tat troatnnnt (T‘ble h). The noun ditfcrnnec botvccn pro~ tad ponttruatncnt scorcs fill statistically insignifictnt. Furthermore, tho 5.30 puttsrn or a 3:111 door-nae 1n acor$gw found 1nd both the for high delta totittty group: v:a graup .--Q-‘-~-"-..-flfifi-.. Table h thout hora .‘..--*-‘Cfl-‘-‘-~‘-fl‘ �an: t Index Low Delta Indox ttrontncnt 1 Score: Prc~ Pout— Kean Trautnent Trontnent Difference 21 h2.2 h0.6 16 h2.6 h2.1 3| High Delta h ~1.6 «0.5 0.1 �DISGU8SION: These observations demonstrate the relevance of tho to the oonvnleivo therapy proooea. in understanding of theeo relationships requiroe oxanination of the payoholegioal factors reflected by the 7 Scale in our population. The obeorvationa on the reverse F scale indicatee that those pationte who diaagroed with the original etatonente (low r eoore) were responding to the content or the otatonente. Thie nae shown by the high degree or agreement with the rarer-o statoaente. However, thoee patiente who agreed with the original etatononto (high I eoere) continued to agree when the etatenente were revereed. Evidently, these patient: were not reephnding to the oontent e! the atatonente, but deaenatrated a noro generalised reaction. There have been several otudioo on nenpeyohiatrio populations neing a reverse I soelo, with conflicting reenlte. Thno, Christie, floral and Seidonberg (3) have found a coneiatont roeponeo to content in original and rovoreo ooaloe, o. ., agreeing to one and disagreeing with the other, while Jackson, Heeeiok and Selley (9) retort a positive correlation between agreement on the two eoalee. In part, theoe dittoronooe nay be accounted for by difference: in the tern of the rovoreod eoalo. Jackson and Heeeiok (10) indicated that Chrietie gt 3;. (3) modified the language fora of the original scale and reversed the content, while Jaokeon et a1. (9) retained the extreao, olioho1ridden etyle e: the original eoalo. Jackson and noeeick indicate that the reeponoo pattern to 7 Scale �«91- the 1 Scale nsy be interpreted in terne of response style rsther then specific item content. 0n the besis or the dots from our popnlsticn there is s difference between the high end low scores with respect to the extent thst cognitive style effects their response. the high scorers who egree with both ferns or the sonic lion s consistent style of response ecqniescsnoe, evergenerelisetien end contorning to secislly desireble stendsrds. Those who scored low on the originsi sosie, however, did not shoe the converse -. s consistent psttern or negotivisn or sociel nenvcentornity. they eltered their style to egree with the content when the ststononts were reversed. ‘Thns, low I score petients were cherscteristicsily nore critical snd.decrildnsting persons, while these with high I scores were norc nndittcrontieting end stereotyped in their resctione. With this conception of the r Seth, the findings in convulsive thorspy may be considered. In the selection or trectnent in this institntion, those psticnts receiving convulsive therapy had significantly higher scores then those recciving psychotherapy only (17). That this observs~ tion is not Just e reflection of diagnosis is seen in the dittorsntietion by the F score of the selection of trestnent oven snong those pstients clsssitied es psychotic depression. The selection of treatment than scone related to poyohologicsl processes reflected in the r Scale. Subjects with high I �-10. scores, with etereetypy of thinking end difficulty in introepectien, often preeent a behavioral pattern incompatible with the eatebliehaent of the type of interpereenal reletien~ ehipe required in peycheanalytically-eriented psychotherapy. The favorable evaluatiene of therapetic reopenee to eonvulaive therapy in patienta with high I acoree nay be related to pereenality attributee. The psychological prov eeeaee reflected in the I Scale are similar to those pereonality factors previeuely related to a favorable rcepenae to each treatment. In structured family intervieea it vat observed that the faverabl! rated patients had personality patterns characterised as neuenpathic, conintrespectivc, nenverbally eeamenicative, and highly conventional and stereotyped, with little nonnative or creative capacity (13). Genaistent patterns have been aheen in Rcrachaeh etudiee indielting that good prognosis in related to a small number of reepeneee, absence of human movement and little divereifieatien of content (15; 7). The F acere increecee significantly with cenvuleive therapy with the extent of increase related to the degree of altered brain function, as measured by the degree of induced EEG slow wave activity. This relation of change in behavior to physiological change is an observation that has been coneietently noted in cenvulaive therapy patients (h). The increaee in I accre during treataent may have been even �nere marked than eetnelly observed. Severel patients of tereignobirth and little edneetion hed retina: er nee: nexinnn eeeree print to treatment, thne elinineting or reducing the peeeibility er en increeee en retenting. The ehenge in eeere with altered brein function is eeneietent with previous obeervetiene on the behevierel effects 0: convulsive therapy. In eeeerd with our oeueeptnel trenewerk, greater egreenent with I Scele items during treete tent in related to inereeeed etereetypy and difficulty in dieerininetien, ll velx ee increeeed eeqeieeeenee. rue 1e preeeee whieh hee been noted 1n‘11ngn1et1e, e e! general pert neeeuree. and In their behavierel clinieel perceptual language, cenvnleive therepy patient: shew inereeeed deniel, cliche: end etereetyped end er use eve-inn, qualification expreeeiene (16). They elee nenifeet increased repetitiveneee of words (11), difficulty in aenplex Vienel end tectile per— eeptien (6) end figureggreund discriminetien (1h). Clinieelly, eke they chereeterieticelly here oeup}1ent end ecqnieecent and try to pleeee the exeniner (S). �-12- annular: neaenre e: social attitude, the California 1 Scale, has been utilised in etadiee o! the convulsive therapy proceee. In a voluntary psychiatric hoepital it wee noted that patients referred for oonvnlaive therapy had eigniticantly higher I A aoorea than theee receiving psychotherapy only. Anon; the patiente receiving convulsive therapy, theee with the higher initial 7 ecoree were evaluated ae showing the beet clinical reellta. With treatment there waa a significant increase in r ecore, with the ineroaae related to the degree or altered brain function. Following treataent the ecoree returned to their; original level. comparison of reenlte with a conventional and "reverne'l r eoale concentrated that low I acore patiente respond to the content or the questionnaire, while these with high I eoeree ahowed a generalized pattern or agreement independent of the content. There results are interpreted in tern: of the psychological proceeeee neaenred by the F Scale. High 1 score patients are coneidered to be aterectyped in their thinking and to have ditticnlty in introspection ~- behavior whih is incompatible with peychoanalytioally-oriented psychotherapy, rendering than acre liable to referral for convnleive therapy. With treatnent, enoh patients are aleo acre likely to develop the language patterna of denial and nee o: cliche} which are the one: for evalnatione or clinical improvement. the inoreaae in I score with treataont is conparahle to the other types of behavioral �ohnnxo, such :- 1n figure—around of lungntga. inerouocd noqniouconcc, increased ditticnlty disarininntign, tad incroalod stereotypy �Reference- 1. Aderno, !.H., Frankel—Brunswick, 3., Levin-on, D.J. and Sanford, 1.3. The Antheritarian Pereonalitz. Harper, low rerk, 1950. 2. ‘Baee, B. n. Antheritarianion or aeqniooeenoe? J. Abnern. & scan Pezeho1., 5;. 611~623, 1955. 3. chriotie, 3., Havel, 3., and Beidenberg, I. II the P Scale irreversible? J. Abnorn. flee. Pezche1., fig: I 1h3~1§9, 1958. Fink, H. and Kahn, R.L. Reletion of EEG delta activity to behavioral reeponee in electroshock: quantitative eerial etndiee. 1.x.i. Arch. Henrol. & Po ehiat., 1Q; 516-525, 1957. 3.2. and 3ehaviora1 patterno in induced Kahn, n. Iink, etetee or altered brain function. Paper read at Diviaional Meeting, Aner. Peyohiat. Lee., low York, levenber, 1957. 6. Fink, H., Iahn, R.L. and Kevin, 3. Effects of diffuse eltered brain tnnntien en perception. Proc. 1? Int. sonar. szohel. Anatordans Northelolland Pnb1., V pp. 238-239, 1959. Fink, x., Kahn, R.L. and Pollack, Psychological factors attenting individual ditteronoee in behavioral response to convuleive therapy. J. lorv. & lent. Dio., M. 128: 2h3~2h8, 1959. �-2Referancoa Gallagher, E.B., Ltviason, D.J. and Erlich, I. Some sociopsycholcgical chaructoriatics of patiants and their rclavuneo tor paychintric treatnont. In Groonblntt, 9.5. Lovinlon und 3.x. Williams (Edl.) The Pttiont und the Hpntnl iosgittl. The Pro. Prosl, H. alencoo, 111. pp. 357-379, 195?. Jack-on, 3.3., Herrick S.J., and Bailey, c.n. 30v “rigid“ is the autharitnrinn? J. Abnorm. soc. Pnzchol. fig: 137~1h0, 1957. 10. Junk-tn, 9.1. and Herrick, 5.3. content and style in personality anion-none. Patchol. 3‘11., 2;: 2&3-252, 1958. 11. antic, 3., Fiat, R.L. Communication pattorns with ulterod brain function. J. Harv. & Rent. 313., H. and Kuhn, in prons. 12. 8.1., link, E. 3nd WeinttOin, E.A. Relation of anobarhital tent to clinical inprovonont in oloctro¢ Kuhn, shook. A.H.A. Arch. Konrol. Pazchint., 1g. 23»29, 1956. 13. Inna, 1.1. ind link, x. Personality factor: in bohuvior¢1 response to olootraahook thornpy. J. learn I ehiut., l3 h5-h9, 1959. Inna, R.L., Pellaek, l. £34 rink, H. Figaro-ground dinorininaticn after indueod ultcrod brain inaction. A.H.A. Arch. louroi.,fiiu pron: �15. rink, H. Prague-tie value at hereohaeh criteria in clinical response to convulsive therapy. Kuhn, R.L. and Paper read at Bleetreeheck Reaeareh Aee., san Francisco, 1958. 16. Iahn, R.L. and link, H. changes in language during oleetroeheck therapy. In P. flesh and J. Znhin (Ede.), Pazehegatholegz et columnieatien. Grune and stratten, l.‘ Yorke ppe 126‘139e 1958a R.L., Pellaek, H. and link, H. social tactora 1n the selection at therapy in a veluntary mental helpital. J. Hill-1h Hung. Q: nos-:20, 1957. 18. Iahn, n.L., rellaek, H. and rink, u. seexepeyehelexieal aepeete at fieyehiatrie treatleut. Arch. Gen. Pezchiat., in press. 17. Kahn, �Social Attitude Questionnaire (F Scale)* Below are a number of‘statements. For each statement we want you to give us your personal opinion of'whether you agree or disagree, and how much. .3 g 5 8 >3 am :> o (I) :4 fi g >> +3 43 m a {34 m (D M m r1 9 +2 'H H c6 w 0) 3 3 vi H 8 E g 5’ S pm (D ((3 Q1 L" w m a) m a) m m p ’ 0 h w (6 m aw £6 m better When talk less ho w no a -H "-4 rd 0 F1 Pi F4 F4 F1 +4 H U U ................... and work more, everybody would be offOOCOICOOOOOQ. OOOOOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOOOOOOOOO . think about it, it is best for him not to but to keep busy with more cheerful things ....... a person has a problem or worry, the youth needs most is strict discipline, rugged determination, and the will to work and fight for family and country ...... What I different kinds of people mix together to protect himself especially carefully infection or disease from them ............... Nowadays when so many so much, a person has against catching an crimes, such as rape and attack on children, deserve more than mere imprisonment; such criminals ought to be publicly whipped, or worse....... . Sex ................... ..................... best teacher or boss is the one who tells us exactly what is to be done and how to go about it. ...... . The ..................... people sometimes get rebellious ideas, but as they grow up they ought to get over them and settle down Young People can be divided into two the strong.... ..... ... *From ...................... distinct classes: the weak and .................. ........................ . Gallagher, Levinson and Erlich (1957). Scoring: I agree very much ....... +7 I agree pretty much.....+6 I agree a little ........ +5 I can't say ............ I disagree very much ....... +1 I disagree pretty much ..... +2 I disagree a little +3 +h 43 ho w ....................................... people would h aw m -H 5-4 Science has its place, but there are many important things that must always be beyond human understanding If h a $4 sane, normal decent person could ever think of hurting a close friend or relation.. No 8 ........ $3 as �Appendix Social Attitude Questionnaire (F Scale)* Felow are a number of statements. For each statement we want you to give us your personal opinion of whether you agree or disagree. Answer each statement according to one of the following: I AGREE A LITTLE I DISAGREE A LITTLE I AGREE PRETTY MUCH I DISAGREE PRETTY MUCH I AGREE VERY MUCH I DISAGREE VERY MUCH 1. sane, normal, decent person could ever think of hurting a close friend or relation. No 2. Science has its place, but there are many important things must always be beyond human understanding. 3. If better off. that people would talk less and work more, everybody would be a person has a problem or worry, it is best for him not to think about it, but to keep busy with more cheerful things. tion, A. When 5. What and the the youth needs most is will to strict discipline, rugged determina— fight for family and country. 6. Nowadays when so many different kinds of people mix together much, a person has to protect himself especially carefully against catching an infection or disease from them. work and so 7. Sex crimes, such as rape and attack on children, deserve more than mere imprisonment; such criminals ought to be publicaly whipped, or worse. is 8. The best teacher or boss to be done and how to go about is the it. one who tells us exactly what people sometimes get rebellious ideas, but as they grow up they ought to get over them and settle down. 9. 10. Young PeOple can be divided the strong. into two distinct classes: the weak and -————————————.__.__—_—______ * Gallagher, Levinson and Erlich (1957). Scoring: Agreement is scored as +7 (agree very much), +6 (agree pretty much), and +5 (agree a little); +h for no response or uncertain; +3 (disagree a little), +2 (disagree pretty much), and +1 (disagree very much). The ten items are summed for a single F—Scale Score. From �CONVULSIVE THERAPY PROJECT — INTERNATIONAL ASSOCIATION FOR PSYCHIATRIC RESEARCH, INC. §gpia1 Attitude Questionnaire {F ScaIe) aha a numbed 05 Atatemcnia. Fox each Ataiemeni we want you to give uA gout geaéonafi Opinion 05 whethea you agaee Befiow on disagree, and .C.‘ 0 how much. g much m G) very H 94 muc 3 >5 JJ U little - much 4-) a H 1—! pretty very CE! cisagree agree say t can I I sane, normal decent person could ever think of hurting a close friend or relation. ..... ‘u.......... ..... No Science has its place, .............,... but there are many important things that must always be beyond human understanding................ If people would talk less and work more, everybody would be better off.................................................... I ‘ then a person has a problem or worry, it is best for him not to think about it, but to keep busy with more cheerful things.... I If I the youth needs most is strict discipline, rugged determina— tion, and the will to work and fight for family and country... What different kinds of people mix together to protect himself especially carefully infection or disease from them ..... ....... Nowadays when so many so much, a person has against catching an I crimes, such as rape and attack on children, deserve more than mere imprisonment; such criminals ought to be publicly whipped, or worse................... .. Sex I ......... ............... . The best teacher or boss is the one is to be done and hOW tells us exactly what to‘go about ituu'oonltocconcoct-cocooooowho Young people sometimes get rebellious ideas, but as they grow up they ought to get over them and settle down................ People can be divided into two distinct classes: the weak and the strongOIOOIIOOIOOQOOOOOCOOIIOIOOIOIICOOCIOIOOCOOIIOICI I “"“'{' I i, i ' � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Published Works Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Social attitude (California F Scale) and convulsive therapy. J Nerv Ment Dis. 1960 Mar; 130:187-92. Type The nature or genre of the resource Text Identifier An unambiguous reference to the resource within a given context mfp-02-01-003-46-012 Date A point or period of time associated with an event in the lifecycle of the resource 1960 Creator An entity primarily responsible for making the resource Kahn, Robert L.; Pollack, Max; <a title="Fink, Max, 1923-" href="http://id.loc.gov/authorities/names/n79039548" target="_blank">Fink, Max, 1923-</a> Subject The topic of the resource Published Works -- Articles and Reviews Relation A related resource The Max Fink Collection Description An account of the resource [Preprint] with questionaire and reprint. Reprint from THE JOURNAL OF NERVOUS AND MENTAL DISEASE Volume 130, No .3, March 1960 Rights Information about rights held in and over the resource <a title="IN COPYRIGHT - EDUCATIONAL USE PERMITTED" href="http://rightsstatements.org/vocab/InC-EDU/1.0/" target="_blank">IN COPYRIGHT - EDUCATIONAL USE PERMITTED</a> Source A related resource from which the described resource is derived Special Collections and University Archives, University Libraries. Stony Brook University Libraries (State University of New York). Language A language of the resource en-US Format The file format, physical medium, or dimensions of the resource application/pdf Publisher An entity responsible for making the resource available Contributor An entity responsible for making contributions to the resource Published